Table 7.
Comparing studies.
| Author, year of publication | Number of patients (n) | Mean (SD) FEV1 (%predicted) | Mean (SD) age (y) | Study design | Study intervention | Study duration | Outcome measures | Significant difference within groups post training | Significant change pre to post (% baseline) | Significant difference between groups (% change) |
|---|---|---|---|---|---|---|---|---|---|---|
| Aerobic, resistance, and combined aerobic and resistance training | ||||||||||
| Bernard et al., 199966 | 36 COPD: 15 aerobic training (AT), 21 combined aerobic and resistance training (CT) | AT: 39 (12); CT: 45 (15) | AT: 67 (9); CT: 64 (7) | RCT | AT: 30 minutes ergocycle at 80% of Wpeak. CT: AT + RT: 2 sets of 10 reps seated press, elbow flexion and shoulder abduction, leg press, bilateral knee extension, at 60% of 1 RM (progressed to 3 sets of 10 reps at 80% of 1 RM) | 12 weeks (3x/w) | Bilateral thigh MCSA (CT) 1 RM bilateral knee extension | ns AT CT (p < 0.0001) AT (p < 0.005) CT (p < 0.0001) | – ↑8% ↑7.8% ↑20% | CT > AT (p < 0.05) CT > AT (p < 0.05) |
| Ortega et al., 200267 | 47 COPD: 17 resistance training (RT), 16 aerobic training (AT), 14 combined aerobic and resistance training (CT) | RT: 40 (14); AT: 41 (11); CT: 33 (12) | RT: 66 (6); AT: 66 (8); CT: 60 (9) | RCT | AT: 40 min ergocycle at 70% of Wpeak; RT: 4 sets of 6–8 reps chest pull, butterfly, neck press, leg flexion, leg extension at 70–85% of 1 RM; CT: 2 set of 6–8 reps at 70–85% of 1 RM + 20 minutes ergocycle at 70% of Wpeak | 12 weeks (3x/w) | 1 RM leg extension 1 RM leg flexion | RT (p < 0.05) AT (p < 0.05) CT (p < 0.05) RT (p < 0.05) AT (p < 0.05) CT (p < 0.05) | ↑52.8% ↑20.5% ↑52.8% ↑106.7% ↑33.3% ↑88.2% | RT > AT (p<0.001) CT > AT (p < 0.01) RT > AT (p < 0.001) CT > AT (p < 0.01) |
| Spruit et al., 200268 | 30 COPD: 16 aerobic training (AT), 14 resistance training (RT) | AT: 41 (20); RT: 40 (18) | AT: 63 (8); RT: 64 (7) | RCT | AT: 90 minutes: 10 minutes cycling at 30% of Wpeak (progressed to 25 min at 75%), 10 minutes treadmill walking at 60% of average speed 6MWT (progressed to 25 minutes), 4 minutes arm cranking at Borg dyspnea 5 - 6 (progressed to 9 minutes) and 3 min stair climbing (progressed to 6 minutes). RT: 90 minutes: 3 sets of 8 reps quadriceps, pectoralis, triceps at 70% of 1 RM (load was increased with 5% of 1 RM weekly), 3 minutes stair climbing (progressed to 6 minutes), 2 minutes cycling and walking at 40% of Wpeak or averaged speed 6MWT | 12 weeks (3x/w) | Isometric knee extension peak torqueb Maximal isometric knee extension forcec Maximal isometric knee flexion forcec | AT (p < 0.05) RT (p < 0.05) ns AT RT (p < 0.05) AT (p < 0.05) RT (p < 0.05) | ↑42% ↑20% – ↑35% ↑28% ↑31% | AT > RT (p < 0.01) ns between groups ns between groups |
| Mador et al., 200469 | 24 COPD: 13 aerobic training (AT), 11 combined aerobic and resistance training (CT) | AT: 40 (4); CT: 44 (4) | AT: 68 (2); CT: 74 (2) | RCT | AT: 20 min of cycle ergometer at 50% of Wmax (progressed with 10% when patient could cycle for 20 minutes < 5 Borg), 15 minutes treadmill exercise 1.1 to 2.0 mph based on 6MWT with 0% elevation (elevation and speed increased when patient could walk for 15 minutes < 5 Borg). CT: AT + RT: 1 set of 10 reps knee flexion, knee extension, chest press, shoulder abduction, and elbow flexion at 60% of 1 RM (progressed to 3 sets and addition of 5 lb) | 8 weeks (3x/w) | 1 RM quadriceps 1 RM hamstrings | ns AT CT (p < 0.005) ns AT CT (p < 0.03) | – ↑23.6% – ↑26.7% | CT > AT (p < 0.002) ns between groups |
| Panton et al., 200470 | 17 COPD: 8 aerobic training (AT), 9 combined aerobic and resistance training (CT) | AT: 40 (32); CT: 42 (16) | AT: 63 (8); CT: 61 (7) | Non-randomized controlled trial | AT: 30 minutes of arm ergometer, cycle ergometer, Airdyne cycling, treadmill, indoor track walking + 30 minutes chair aerobics. Everything at 50–70% of HRR. CT: AT + RT: 45–60 minutes: 3 sets of 10–12 reps leg press, calf press, seated leg curl, leg extension, chest press, pull down, shoulder press, seated row, crunch, back extension, biceps curl, and triceps extension (when 12 reps could be completed, resistance was increased). | AT: 12 weeks (2x/w); CT: 12 weeks (4x/w) | 1 RM leg extension | ns AT CT (p < 0.05) | – ↑36.5% | CT > AT (p < 0.05)d |
| Phillips et al., 200671 | 19 COPD, 9 aerobic training (AT), 10 combined aerobic and resistance training (CT) | AT: 33 (6); CT: 42 (3) | AT: 70 (2); CT: 71 (1) | RCT | AT: 20 – 40 minutes arm ergometer, treadmill, cycle and stepper (all at 3 MET, RPE < 13 and saturation ≥ 90%), low intensity resistance training with 2 or 3 lb handheld dumbbells (8–10 reps arm curl, lateral torso bend, lateral arm raise, wrist curl, standing triceps extension, and shoulder abduction with arms flexed). Progression: increase with 2–3 reps each session based on RPE < 13, load increased when patient could complete 16–18 reps. CT: AT + RT: chest press, leg press, lat pulldown, cable triceps pushdown, cable triceps curl at 50% of 1 RM (load increased with 5–10% after completion of 10 reps) | 8 weeks (2x/w) | 1 RM leg press | ns AT CT (p < 0.05) | – ↑9% | CT > AT (p < 0.05) |
| Alexander et al., 200872 | 20 COPD: 10 aerobic training (AT), 10 combined aerobic and resistance training (CT) | AT: 39 (15); CT: 30 (13) | AT: 73 (9); CT: 65 (8) | RCT | AT: 20–40 minutes: upper (arm ergometer) and lower limb (treadmill, cycle ergometer, and stepper) at 20–40 bpm above HRrest, breathlessness score 1–5, RPE 11–13 and 3 METs, upper arm strength training at low intensity using handheld dumbbells (1 set of 8–15 reps arm curl, lateral torso bend, lateral arm raise, wrist curl, triceps extension, upright row with 1–10 lbs). Progression: duration was increased before intensity. CT: AT + RT: one set of 12 reps bench press, leg press, pull down, cable triceps pushdown, cable biceps curl at RPE: 11–13 and 50% of 1 RM. Progression: loads increased with 3–5 lb after completion > 12 reps for 2 consecutive sessions | 8 weeks (2x/w) | 1 RM leg press | ns both groups | – | ns between groups |
| Dourado et al., 200973 | 35 COPD: 11 resistance training (RT), 11 combined low intensity training and resistance training (LTRT), 13 low intensity training (LT) | RT: 59 (24); LTRT: 59 (27); LT: 58 (24) | RT: 61 (9); LTRT: 62 (10); LT: 65 (9) | RCT | RT: 60 minutes: 7 exercises on resistance training machines (3 sets of 12 reps, 2 minutes rest, at 50–80% of 1 RM) LT: 60 min: 30 minutes walking, 30 minutes low intensity resistance training with free weights and on parallel bars (3 MET, high reps with low load) LTRT: 60 minutes: 30 minutes RT: 2 sets of 8 reps at 50 – 80% of 1 RM + 30 min LT at half the volume | 12 weeks (3x/w) | 1 RM leg press 1 RM leg extension | RT (p < 0.05) LTRT (p < 0.05) ns LT RT (p < 0.05) LTRT (p < 0.05) ns LT | ↑58.2% ↑48.7% – ↑44.4% ↑21.2% – | RT > LTRT (p < 0.05) LTRT & RT > LT (p < 0.05) RT & LTRT > LT (p < 0.05) |
| Vonbank et al., 201274 | 36 COPD: 12 aerobic training (AT), 12 resistance training (RT), 12 combined aerobic and resistance training (CT) | AT: 58 (19) RT: 58 (16) CT: 51 (20) | AT: 62 (5) RT: 60 (6) CT: 59 (8) | RCT | AT: 20 minutes cycle ergometer at 60% of VO2peak (5 minutes increase every 4 weeks) RT: 2 sets of 8–15 reps lower and upper body (bench press, chest cross, shoulder press, pull downs, biceps curls, triceps extensions, abdominals and leg press) at 8–15 RM (progression: weight increased when > 15 reps were possible and sets increased to 4) CT: AT + RT | 12 weeks (2x/w) | 1 RM leg press | ns AT RT (p < 0.01) CT (p < 0.01) | – ↑39.3% ↑43.3% | RT & CT > AT (p < 0.05) |
| Covey et al., 201475 | 75 COPD: 20 resistance training followed by aerobic training (RTAT), 28 sham training followed by combined aerobic training and resistance training (CT), 27 sham training followed by aerobic training (AT) | RTAT: 42 (10); CT: 41 (10); AT: 39 (9) | RTAT: 68 (6); CT: 68 (8); AT: 68 (7) | RCT | AT: 4 x 5 minutes of stationary cycling at 50% of Wpeak with rest intervals of 2–4 minutes of unloaded cycling (progressed to 80% of Wpeak). RT: 2 sets of 8–10 reps leg press, knee extension, knee flexion, calf raise, hip adduction and hip abduction at 70% of 1 RM (progressed to 3 sets at 80% of 1 RM). CT: AT + RT Sham training: gentle chair exercises | 16 weeks (3x/w) | 1 RM (sum of different muscles) Leg extension endurance: isotonic repetitions at 60% of 1 RM at a cadence of 12 reps per minute until task failure | RTAT (p > 0.001) CT (p < 0.001) AT (p < 0.001) RTAT (p < 0.001) CT (p < 0.001) AT (p < 0.001) | ↑26.7% ↑27.7% ↑13.3% ↑173.8% ↑96.6% ↑46.9% | RTAT > AT (p = 0.006) CT > AT (p = 0.015) ns RTAT vs. CT RTAT > AT (p = 0.001) RTAT > CT (p = 0.05) CT > AT (p = 0.039) |
| Zanini et al., 201576 | 60 COPD: 30 aerobic training (AT), 30 combined aerobic and resistance training (CT) | AT: 46 (14); CT: 51 (16) | AT: 72 (8); CT: 69 (6) | RCT | AT: 30–40 minute treadmill or cycle ergometer at 60–70% of HRmax during 6MWT at Borg dyspnea 3–5, upper limb training (arm ergometer and callisthenics with light weights). CT: AT + RT: 2 sets of 7 exercises, 12–20 reps at 60–70% of 1 RM (progressed when 1 or 2 reps more could be performed on 2 consecutive sessions) | 3 weeks (5x/w) | 1 RM leg extension | ns AT CT (p < 0.001) | – ↑30.3% | Not reported |
| NMES and other training modalities | ||||||||||
| Sillen et al., 201477 | 91 COPD: 33 HF-NMES, 29 LF-NMES, 29 resistance training (RT) | HF: 33 (2); LF: 35 (2); RT: 33 (2) | HF: 64 (1); LF: 66 (1); RT: 64 (1) | RCT | NMES: quadriceps and calf stimulation: 18 minutes at maximal tolerable intensity. LF = 15 Hz, HF = 75 Hz. Pulse width 400 µs, 6 seconds on–8 seconds off cycle. RT: 4 sets of 8 reps leg extension and leg press at 70% of 1 RM with 2 minutes rest (progression of load with 5% every 2 weeks) | 8 weeks (5x/w - 2x/d) | Isokinetic quadriceps peak torque (90°/s)b Isokinetic total work: endurance (90°/s)b | HF (p < 0.01) ns LF RT (p < 0.01) HF (p < 0.03) LF (p < 0.03) RT (p < 0.03) | ↑13.7% – ↑8.3% ↑24.0% ↑8.7% ↑16.3% | HF > LF (p = 0.01) ns HF vs RT ns RT vs LF HF > LF (p = 0.03) ns HF vs RT ns RT vs LF |
| Kaymaz et al., 201578 | 50 COPD: 23 NMES, 27 aerobic training (AT) | NMES: 26 (7); AT: 27 (8) | NMES: 63 (10); AT: 63 (7) | Nonrandomized controlled trial | NMES: quadriceps and deltoid stimulation: 50 Hz, 300–400 µs, 15 minutes, maximum tolerable intensity, active strengthening exercises quadriceps AT: treadmill at 60–85% of VO2max for 15 minutes, cycling at 50–75% of Wmax for 15 minutes, active strengthening exercises | NMES: 10 weeks (3x/w) AT: 8 weeks (3x/w) | Quadriceps MMT score right Quadriceps MMT score left | NMES (p < 0.05) AT (p < 0.001) NMES (p < 0.001) AT (p < 0.001) | ↑0.34 pte ↑0.48 pte ↑0.39 pte ↑0.48 pte | ns between groups ns between groups |
| Tasdemir et al., 201579 | 27 COPD: 13 NMES + combined aerobic and resistance training (CT), 14 sham NMES + combined aerobic and resistance training (CT) | NMES: 29 (16-71); Sham: 42.5 (23-66) (median and IQR) | NMES: 62 (8); Sham: 63 (8) | RCT | NMES: quadriceps stimulation for 20 minutes at 50 Hz, 300 µs, 10 s on–20 s off cycle, intensity set at patient’s maximum tolerance. CT: 30 min cycle and treadmill at 80% of HRmax, 2 sets of 10 reps leg extension at 45% of 1 RM (progressed to 3 sets of 10 reps at 70% of 1 RM), 1 set of 10 reps shoulder girdle and elbow muscles with 0.5–1.5 kg. Sham: NMES at 5 Hz + CT | 10 weeks (2x/w) | 1 RM quadriceps | NMES (p < 0.05) Sham (p < 0.05) | ↑18.4% ↑31.0% | ns between groups |
ns: not significant; RCT: randomized controlled trial; RM: repetition maximum; FEV1: forced expired volume in 1 second; pt: points improvement on manual muscle testing scale 0–5; RPE: rate of perceived exertion; MET: metabolic equivalent; HF/LF NMES: high/low frequency neuromuscular electrical stimulation; MCSA: muscle cross-sectional area; CT: computed tomography; Wpeak/max: peak/maximal workload; 6MWT: 6-minute walking test; HRR: heart rate reserve; HR: heart rate; MMT : manual muscle testing.
aMeasured via strain-gauge system.
bMeasured via computerized dynamometer, for example, Biodex.
cMeasured via hand-held dynamometer.
dBetween groups difference based on post training value.
eOnly absolute values available.